基于马尔可夫模型的盐酸伊立替康脂质体治疗胰腺癌的药物经济学评价OA

OBJECTIVE:Based on the publicly available clinical trial data of PAN-HEROIC-1,from the perspective of China's medical and health system,to analyze the economic value of the regimen of irinotecan hydrochloride liposome combined with 5-fluorouracil(5-FU)and leucovorin(LV),compared with the placebo combined with 5-FU/LV regimen,for the treatment of locally advanced or metastatic pancreatic cancer with failed gemcitabine therapy.METHODS:The Markov model was constructed by using RStudio software,with a 2-week cycle and a simulation duration of 10 years.Total cost,quality-adjusted life years(QALY),and incremental cost-effectiveness ratio(ICER)were selected as the core evaluation indicators to compare the economic efficiency of irinotecan hydrochloride liposome combined with 5-FU/LV regimen and placebo combined with 5-FU/LV regimen.Uncertainty analysis was conducted to verify the reliability of the base-case analysis results,and scenario analysis was performed to explore the regimen value under special conditions.RESULTS:The base-case analysis showed that,compared with the placebo combined with 5-FU/LV regimen,the ICER of irinotecan hydrochloride liposome combined with 5-FU/LV regimen was 541 715.23 RMB per QALY,which was higher than the willingness-to-pay(WTP)threshold(286 345.16 RMB per QALY),indicating a lack of economic efficiency.One-way sensitivity analysis demonstrated that progression-free survival utility and the cost of irinotecan hydrochloride liposome were the key factors affecting ICER.Probabilistic sensitivity analysis revealed that within the current WTP threshold range,the probability of irinotecan hydrochloride liposome combined with 5-FU/LV regimen being more cost-effective was 0.Scenario analysis indicated that when all patients met the eligibility criteria for patient assistance program,the ICER of irinotecan hydrochloride liposome combined with 5-FU/LV regimen decreased to 284 693.64 RMB per QALY,which was lower than the WTP threshold,reflecting economic advantages.CONCLUSIONS:Irinotecan hydrochloride liposome combined with 5-FU/LV regimen does not exhibit economic efficiency as a second-line treatment for patients with locally advanced or metastatic pancreatic cancer with failed gemcitabine therapy.However,the regimen can demonstrate economic advantages under the condition of full coverage of patient assistance program.